Mental Health Forms

Adult Voluntary Admission (MHL 1)

Adult Voluntary Admission Successive Application (MHL 1a)

Voluntary Admission -Minor (MHL 2)

Voluntary Admission -Minor- Successive Application (MHL 2a)

Adult Voluntary Applicant's Notification of Intent to Leave (MHL 3)

Notification of Intent to Leave of a Minor by Parent, Guardian or Next of Kin (MHL 4)

Notification of Intent to Leave of a Minor (MHL 4a)

Notification to Patient of Decision to File Application for Civil Court Certification -Adult & Minor (MHL 5)

Notification to Legal Guardian of Decision to File Application for Civil Court Certification -Adult & Minor (MHL 6)

Rights of Patients (MHL 8)

Rights of Patients - Periodic Review (MHL 8a)

Application for Emergency Certification (MHL 11)

Notification of Rights to Persons Admitted to a Facility on an Emergency Application (MHL 13)

Denial of Request for Discharge (MHL 17)

Confidential Report of Incident (MHL 18)

Application for BH Adult Services DCYF Transition Age Youth March 2024.pdf PDF file, about 1

For Civil Court Certification:

Petition for Civil Court Certification (MHL 15)
Petition for Instructions
Psychiatrists Certificate (MHL 16)

Mental Health Psychiatric Rehabilitative Residences (MHPRR) Application

Prior to submitting an MHPRR application, all alternatives must be explored to keep a client living safely, in a least restrictive level of care, in the community. Alternatives to group home placement which should be considered and ruled out are:

Involvement with a community mental health center (CMHO) which would provide outreach, assisted living and/or a supervised apartment with increased supervision by the client’s identified CMHO.
His or her own apartment, with supervision and/or medication maintenance that is overseen by the Assertive Community Treatment (ACT) team from the client’s CMHO.

Involvement with mental health court (COOP) and documented failure of the attempts mentioned above to keep the client safe, because of the need for increased structure due to the client’s chronic mental illness, would be a clearer indicator that the client is in need of MHPRR placement.